Spiritual Interventions in Veterans with PTSD: A Systematic Review

Journal of Religion and Health - This article reports the results of a systematic review on the effectiveness of religious/spiritually (R/S)-based interventions in veterans with post-traumatic...     

Spiritual Well-Being, Cortisol, and Suicidality in Croatian War Veterans Suffering from PTSD

We present our preliminary results of work that aims to observe the relationship between the cortisol level, the level of spiritual well-being, and suicidal tendencies in Croatian war veterans suffering from PTSD. The survey was conducted on 17 PTSD veterans who completed the Spiritual Well-Being Scale and the Beck Hopelessness Scale. The plasma cortisol level was obtained by venepuction at 8.00, 12.00, 13.00, 16.00, and 22.00 h. Results showed that veterans with higher spiritual well-being scores had lower cortisol levels, and evening cortisol levels showed significant correlation with suicidal risk. The results of the present study could be a stimulus for further investigation into spiritually based interventions, exploring their impact both on mental status and physical health.     

Health Risk Behaviors and Their Relationships to Health Care Utilization Among Veterans Receiving Primary Medical Care

This paper reports the findings of a behavioral health risk screening form and examines the interrelationships among behavioral risk factors and health care utilization. Participants were 1,000 veterans who completed a brief self-report questionnaire assessing affective distress and behavioral health risk factors while they waited to see their primary care provider. Participants reported a mean level of affective distress in the mild range on a scale of 0 to 20 (M = 6.4, SD = 4.95), and 22.4% reported moderate or high levels of affective distress. Fifty percent of the sample denied alcohol use; 5% of the men and none of the women reported a pattern of use that met established criteria for at-risk drinking. Twenty-six percent of the sample reported current tobacco use, 45% acknowledged concerns about diet and/or weight, and 54% reported concern about pain. These factors were largely significantly intercorrelated and several were related to indices of health care utilization. It was concluded that veterans receiving health care in primary care settings report significant levels of affective distress and other health risk behaviors and that the presence of these factors is associated with increased use of the health care system. These data encourage increased efforts to identify these factors and to develop behavior change interventions.     

PTSD Symptom Severity and Family Adjustment Among Female Vietnam Veterans

This study examined relations between posttraumatic stress disorder (PTSD) symptom severity and several family adjustment variables among a sample of 89 female Vietnam veterans and their male relationship partners. Findings revealed associations between PTSD symptom severity and measures of marital adjustment, family adaptability, family cohesion, parenting satisfaction, and psychological abuse. Results suggest that the presence of PTSD symptomatology may have important implications with regard to the family life of female Vietnam veterans.     

Family-Involved Mental Health Care Among OEF/OIF Veterans With and Without PTSD Using VHA Administrative Records

Prior research indicates that veterans are interested in including family members in health care and that family-inclusive mental health treatment can improve treatment outcomes. Consequently, the Veterans Health Administration’s (VHA) directive requires providers to offer family-inclusive mental health services to veterans. However, the extent to which veterans engage in family-inclusive mental health services at the VHA remains unclear. Using data from a longitudinal registry of male and female veterans with and without posttraumatic stress disorder, we examined the extent to which veterans included family members in their mental health care and predictors of engagement in family-involved therapy visits using VHA administrative records over a 5-year time span. Of the 1,329 veterans who received mental health care during the study, 8.4% received a family therapy visit—the number of visits per veteran ranged from 1 to 34. Results from logistic regressions indicate that relative to White veterans, Black veterans were 61.0% less likely to receive a family-involved therapy visit. Married veterans or veterans living with a partner, and veterans with poor romantic relationship functioning, were more likely to receive a family-involved therapy visit. These findings indicate that only a small percentage of veterans received a family therapy visit across 5 years. Efforts to understand barriers to family-involved therapy visits and strategies to increase engagement in family-involved visits may improve clinical outcomes and promote patient-centered care.     

Implementing Group CBT for Depression Among Latinos in a Primary Care Clinic

Depression in low-income Latino populations can be treated using group cognitive behavioral therapy (GCBT). However, effective delivery of GCBT for depression in primary care settings is often impeded by high dropout rates and poor homework adherence. In this study, we describe the structure, processes, and outcomes (including attendance, homework completion, and symptom measures) of GCBT for Spanish-speaking Latino patients with depression in an urban public sector primary care setting. For this study, 96 Latino patients in a primary care clinic participated in at least 1 session of GCBT. Although depressive symptoms among these patients, as measured by the PHQ-9, significantly decreased during treatment, attendance and homework completion were limited. Even with a strategy in place to allow patients to continue in treatment after missing several sessions, 23% of patients dropped out of therapy following their initial session, and approximately half of all patients completed less than 50% (or 8) therapy sessions. Homework was only completed 23% of the time it was checked. Greater session attendance prospectively predicted lower depressive symptoms over time. We discuss potential strategies to increase engagement, treatment effects, and symptom reduction for depression in primary care settings.     

Spiritual Beliefs and Barriers Among Managed Care Practitioners

Purpose: Ninety percent of American adults believe in God and 82% pray weekly. A majority wants their physicians to address spirituality during their health care visit. However, clinicians incorporate spiritual discussion in less than 20% of visits. Our objectives were to measure clinician beliefs and identify perceived barriers to integrating spirituality into patient care in a statewide, primary care, managed care group. Methods: Practitioners completed a 30-item survey including demographics and religious involvement (DUREL), spirituality in patient care (SPC), and barriers (BAR). We analyzed data using frequencies, means, standard deviations, and ANOVA. Findings: Clinicians had a range of religious denominations (67% Christian, 14% Jewish, 11% Muslim, Hindu or Buddhist, 8% agnostic), were 57% female and 24% had training in spirituality. Sixty-six percent reported experiencing the divine. Ninety-five percent felt that a patients spiritual outlook was important to handling health difficulties and 68% percent agreed that addressing spirituality was part of the physicians role. Ninety-five percent of our managed care group noted 8lack of time as an important barrier, lack of training was indicated by 69%, and 21% cited fear of response from administration. Conclusions: Managed care practitioners in a time constrained setting were spiritual themselves and believed this to be important to patients. Respondents indicated barriers of time and training to implementing these beliefs. Comparing responses from our group to those in other published surveys on clinician spirituality, we find similar concerns. Clinician education may overcome these barriers and improve ability to more fully meet their patients expressed needs regarding spirituality and beliefs.*This material has previously been presented as an abstract at the Culture and End of Life Conference, Association of Medical Colleges Spirituality, Kansas City, MO, September 12–14, 2002.Project supported by the Foundation for Spirituality in Medicine, Baltimore, MD     

Burnout and Depression Among Roman Catholic Secular,Religious, and Monastic Clergy

Burnout and depression among Roman Catholic secular, religious order, and monastic (Cistercian) priests was investigated using the Maslach Burnout Inventory (MBI) and the Center for Epidemiological Studies-Depression (CESD) scale. Additionally, a Self-Report-Inventory (SRI) was included requesting information on demographics as well as four categories of predictor variables (vocational satisfaction, social support, spiritual activities, and physical environment) associated with burnout and depression. All participants were randomly selected. The survey yielded a return rate of 90.67%. Secular clergy reported significantly greater emotional exhaustion than did monastic clergy. Secular priests also had significantly greater depression (72%), when compared to religious (40.8%) and monastic (39.5) clergy. Overall group comparisons revealed that secular clergy experienced the highest degree of burnout and depression, monastics the least, and religious priests falling in between. The lack of social support and sense of isolation, for secular clergy, were key elements associated with their experience of both burnout and depression. Candidate in Psychology atand a Psychology Intern at the Ohio State University     

Presence of PTSD is Associated with Clinical and Functional Impact in Veterans with Depression Treated in Community-Based Clinics

Journal of Clinical Psychology in Medical Settings - Providers in non-traditional mental health settings (e.g., primary care, community medical clinics) face challenges involving patients who often...     

Behavioral Health Services Influence Medical Treatment Utilization Among Primary Care Patients with Comorbid Substance Use and Depression

Although research has shown benefits of integrating psychological care in primary care settings, it is unclear how this form of treatment impacts individuals with comorbid substance use and depression. The findings are also mixed concerning how frequently this comorbid population seeks primary care services. This study examined the associations between substance use, depression, and medical treatment utilization among 224 primary care patients. The aim of the investigation was twofold. First, to determine if depression increases medical treatment utilization among patients with substance use disorders; second, to evaluate if behavioral health treatment reduces medical service utilization. A moderated mediation model with bootstrapping analyses revealed that depression strengthened the relationship between substance use and primary care treatment utilization (both medical and behavioral health). The model also indicated that behavioral health services were associated with fewer primary care visits for individuals with comorbid substance use and depression. Clinical and social implications are discussed.     

Interplay Between Service Era,PTSD Symptom Expression,and Treatment Completion Among Veterans

The current veteran population has grown significantly as a result of 3 recent major conflicts: Vietnam, Persian Gulf War, and Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF). Despite a strong presence in VA PTSD specialty clinics nationwide, little is known about how these veteran cohort groups differ in PTSD symptom presentation. Additionally, it is unclear how variations in PTSD symptom presentation may in turn affect treatment adherence and completion. Understanding factors associated with treatment dropout from exposure-based therapy for PTSD is an important area of study, as individuals who drop out of treatment are likely to remain symptomatic and experience significant impairment across a number of psychosocial domains. The present study examined the relationship between service theater affiliation and pretreatment symptom expression as predictors of treatment completion in a sample of 164 veterans. Although treatment completion did not differ by service era, study data revealed statistically significant differences in initial PTSD symptom expression. Implications of the results and future directions are discussed.     

Prolonged Stress,PTSD, and Depression Among School Aggressors and Victims

Exposure rates to school aggression as an aggressor, victim, aggressive victim, or a bystander is high, with large numbers of school-aged children reporting being subjected to verbal or physical violence. We hypothesized that all 3 clusters of the DSM–IV designation of posttraumatic stress disorder (PTSD; Criterion B: Intrusive recall, Criterion C: Avoidance, and Criterion D: Hypervigilance) would be experienced by pure victims, pure aggressors, and aggressive victims. We also anticipated that PTSD symptoms would lead to depression, primarily for victims. Questionnaires were given to 1,398 students, yielding 1,116 valid questionnaires (80% response rate). Respondents were enrolled in the general education system, from 9 different schools in Israel. Following calibration of the research instruments using exploratory and confirmatory factor analyses, a series of structural equation and reflection models were examined. The path through some of the symptoms of PTSD and depression was apparent only for victims. For the victims, the indirect model through avoidance predicted depression only for relational victimization. No clear linkage was found among aggression, PTSD, and depression for aggressors. For aggressors, physical aggression was linked with the 3 clusters of PTSD symptoms, but not with depression.     

Prevalence and Nature of Spiritual Distress Among Palliative Care Patients in India

In palliative care research, little attention has been paid to the empirical study of spirituality in patients in non-Western countries. This study describes the prevalence and nature of spiritual distress among Indian palliative care patients. Data from 300 adult cancer patients who had completed a questionnaire with 36 spirituality items were analyzed. Spirituality was shaped by the Indian religious and economic context. A latent class analysis resulted in three clusters: trustful patients (46.4 %), spiritually distressed patients (17.4 %), and patients clinging to divine support (36.2 %). After regression, the clusters were found to be associated with pain scores (p < .001), gender (p = .034), and educational level (p < .006). More than half of the patients would benefit from spiritual counselling. More research and education on spirituality in Indian palliative care is urgently required.     

Depression and Anxiety in Roman Catholic Secular Clergy

A nationally selected random sample of Roman Catholic secular priests was investigated using the Center for Epidemiological Studies-Depression scale and the State-Trait Anxiety Inventory Form Y. Additionally, a Self-Report Inventory requested information regarding participants' demographics as well as four categories of predictor variables (i.e., Vocational Satisfaction, Social Support, Spiritual Activities, Physical Environment) potentially associated with depression and anxiety. The study yielded a return rate of 64%. Secular clergy reported significantly greater depression and anxiety (both state and trait) than are reported in the general population. Low Vocational Satisfaction was found to be predictive of depression as well as both state and trait anxiety. Additionally, low Social Support was found to be predictive of state and trait anxiety. When the significant predictor variables were conceptually collapsed, it appeared that both people and place were significantly related to Roman Catholic secular priests' experience of depression and anxiety.     

Comparisons Between Patients Diagnosed with PTSD in Primary Care Versus Mental Health Care in Five Large Civilian Health Care Systems

Journal of Clinical Psychology in Medical Settings - Posttraumatic stress disorder (PTSD) is a serious mental health disorder that may not be adequately detected or treated in primary care (PC)....     

Performance of Mental Health Counselors in Integrated Primary and Behavioral Health Care

Integrated primary and behavioral health care (IPBH) is becoming a preferred mode of service delivery in the United States. Integrated care includes the participation of medical and mental health professionals, such as mental health counselors. The clinical outcomes of these professionals need to be studied to determine their effectiveness in such settings. We examined the performance of 10 mental health counselors on the clinical outcome of 1,747 clients treated in an IPBH center. Analyses using growth curve modeling and pre‐post test design revealed that mental health counselors were effective overall, but they differed in client dropout rates and efficiency in reducing clients' initial symptoms. We used the analyses to rank order counselors based on their effectiveness. Counselors who were the most effective varied in their efficiency but demonstrated the lowest client dropout rates. Implications for future research and counseling practice were discussed.     

The Spiritual Needs and Resources of Hospitalized Primary Care Patients

Previous studies have recognized the importance of hospitalized primary care patients’ spiritual issues and needs. The sources patients consult to address these spiritual issues, including the role of their attending physician, have been largely unstudied. We sought to study patients’ internal and external resources for addressing spiritual questions, while also exploring the physician’s role in providing spiritual care. Our multicenter observational study evaluated 326 inpatients admitted to primary care physicians in four midwestern hospitals. We assessed how frequently these patients identified spiritual concerns during their hospitalization, the manner in which spiritual questions were addressed, patients’ desires for spiritual interaction, and patient outcome measures associated with spiritual care. Nearly 30% of respondents (referred to as “R/S respondents”) reported religious struggle or spiritual issues associated specifically with their hospitalization. Eight-three percent utilized internal religious coping for dealing with spiritual issues. Chaplains, clergy, or church members visited 54% of R/S respondents; 94% found those visits helpful. Family provided spiritual support to 45% of R/S respondents. Eight percent of R/S respondents desired, but only one patient actually received, spiritual interaction with their physician, even though 64% of these patients’ physicians agreed that doctors should address spiritual issues with their patients. We conclude that inpatients quite commonly utilize internal resources and quite rarely utilize physicians for addressing their spiritual issues. Spiritual caregiving is well received and is primarily accomplished by professionals, dedicated laypersons, or family members. A significantly higher percentage of R/S patients desire spiritual interaction with their physician than those who actually receive it.     

Identification and Follow-Up by Primary Care Doctors of Children with PTSD After Terrorist Attacks

Abstract

Many children and adolescents were among the victims of the suicide bomb attacks in Israel since March, 2000. While the number with emotional and behavioral symptoms was expected to be high, very few children who developed terrorism-related posttraumatic stress disorder (PTSD) were actually referred to mental health professionals for assessment or treatment. Prolonged exposure to terrorism lowers even further the number of children who remain in treatment. This article discusses reasons and presents a training program for primary care providers (pediatricians, family doctors) in identifying PTSD in child victims, and for mobilizing them to carry out long-term follow-up of these children.